What constitutes an emergency ambulance call?

Mills, Brennen; Hill, Michella; Buck, John R.; Walter, Ella; Howard, Kayla; Raisinger, Alex; Smith, Erin

doi:10.33151/ajp.16.626

Cited by 14 publications

(16 citation statements)

References 27 publications

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“…However, this does not imply that SCs are not useful. Specifically, our data confirm a prior study showing that the lay population has difficulties reliably identifying medical emergencies [ 25 ]. On average, participants failed to identify every third emergency, and 12% (11/91) of our participants identified emergencies less reliably than the worst-performing SC.…”

Section: Discussionsupporting

confidence: 88%

Benchmarking Triage Capability of Symptom Checkers Against That of Medical Laypersons: Survey Study

Schmieding¹,

Mörgeli²,

Schmieding³

et al. 2021

J Med Internet Res

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Background Symptom checkers (SCs) are tools developed to provide clinical decision support to laypersons. Apart from suggesting probable diagnoses, they commonly advise when users should seek care (triage advice). SCs have become increasingly popular despite prior studies rating their performance as mediocre. To date, it is unclear whether SCs can triage better than those who might choose to use them. Objective This study aims to compare triage accuracy between SCs and their potential users (ie, laypersons). Methods On Amazon Mechanical Turk, we recruited 91 adults from the United States who had no professional medical background. In a web-based survey, the participants evaluated 45 fictitious clinical case vignettes. Data for 15 SCs that had processed the same vignettes were obtained from a previous study. As main outcome measures, we assessed the accuracy of the triage assessments made by participants and SCs for each of the three triage levels (ie, emergency care, nonemergency care, self-care) and overall, the proportion of participants outperforming each SC in terms of accuracy, and the risk aversion of participants and SCs by comparing the proportion of cases that were overtriaged. Results The mean overall triage accuracy was similar for participants (60.9%, SD 6.8%; 95% CI 59.5%-62.3%) and SCs (58%, SD 12.8%). Most participants outperformed all but 5 SCs. On average, SCs more reliably detected emergencies (80.6%, SD 17.9%) than laypersons did (67.5%, SD 16.4%; 95% CI 64.1%-70.8%). Although both SCs and participants struggled with cases requiring self-care (the least urgent triage category), SCs more often wrongly classified these cases as emergencies (43/174, 24.7%) compared with laypersons (56/1365, 4.10%). Conclusions Most SCs had no greater triage capability than an average layperson, although the triage accuracy of the five best SCs was superior to the accuracy of most participants. SCs might improve early detection of emergencies but might also needlessly increase resource utilization in health care. Laypersons sometimes require support in deciding when to rely on self-care but it is in that very situation where SCs perform the worst. Further research is needed to determine how to best combine the strengths of humans and SCs.

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Section: Discussionsupporting

confidence: 88%

Benchmarking Triage Capability of Symptom Checkers Against That of Medical Laypersons: Survey Study

Schmieding¹,

Mörgeli²,

Schmieding³

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…As previously reported [ 15 , 23 ], laypersons’ ability to triage is systematically biased toward overtriage, but they tend to miss emergency cases. However, when analyzing actionable metrics of triage ability, we see a majority of laypersons being fairly competent (accuracy ≥75%) in deciding whether they should seek health care (decision 2) and whether emergency care is required (decision 1).…”

Section: Discussionmentioning

confidence: 65%

“…For example, previous studies indicate that laypersons tend to overtriage [ 13 ] and that women rate symptoms as more urgent than men [ 14 ] and are thus potentially even more inclined toward overtriage. Moreover, an Australian study showed that although laypersons are risk averse when making triage decisions, they cannot reliably detect emergencies either [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

The Triage Capability of Laypersons: Retrospective Exploratory Analysis

Kopka¹,

Feufel²,

Balzer³

et al. 2022

JMIR Form Res

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Background Although medical decision-making may be thought of as a task involving health professionals, many decisions, including critical health–related decisions are made by laypersons alone. Specifically, as the first step to most care episodes, it is the patient who determines whether and where to seek health care (triage). Overcautious self-assessments (ie, overtriaging) may lead to overutilization of health care facilities and overcrowded emergency departments, whereas imprudent decisions (ie, undertriaging) constitute a risk to the patient’s health. Recently, patient-facing decision support systems, commonly known as symptom checkers, have been developed to assist laypersons in these decisions. Objective The purpose of this study is to identify factors influencing laypersons’ ability to self-triage and their risk averseness in self-triage decisions. Methods We analyzed publicly available data on 91 laypersons appraising 45 short fictitious patient descriptions (case vignettes; N=4095 appraisals). Using signal detection theory and descriptive and inferential statistics, we explored whether the type of medical decision laypersons face, their confidence in their decision, and sociodemographic factors influence their triage accuracy and the type of errors they make. We distinguished between 2 decisions: whether emergency care was required (decision 1) and whether self-care was sufficient (decision 2). Results The accuracy of detecting emergencies (decision 1) was higher (mean 82.2%, SD 5.9%) than that of deciding whether any type of medical care is required (decision 2, mean 75.9%, SD 5.25%; t>90=8.4; P<.001; Cohen d=0.9). Sensitivity for decision 1 was lower (mean 67.5%, SD 16.4%) than its specificity (mean 89.6%, SD 8.6%) whereas sensitivity for decision 2 was higher (mean 90.5%, SD 8.3%) than its specificity (mean 46.7%, SD 15.95%). Female participants were more risk averse and overtriaged more often than male participants, but age and level of education showed no association with participants’ risk averseness. Participants’ triage accuracy was higher when they were certain about their appraisal (2114/3381, 62.5%) than when being uncertain (378/714, 52.9%). However, most errors occurred when participants were certain of their decision (1267/1603, 79%). Participants were more commonly certain of their overtriage errors (mean 80.9%, SD 23.8%) than their undertriage errors (mean 72.5%, SD 30.9%; t>89=3.7; P<.001; d=0.39). Conclusions Our study suggests that laypersons are overcautious in deciding whether they require medical care at all, but they miss identifying a considerable portion of emergencies. Our results further indicate that women are more risk averse than men in both types of decisions. Layperson participants made most triage errors when they were certain of their own appraisal. Thus, they might not follow or even seek advice (eg, from symptom checkers) in most instances where advice would be useful.

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“…Since there are several factors to consider such as socioeconomic, cultural factors, and patients' personal situations, it is very difficult to analyze the adequacy of EMS system use and establish unified criteria. e use of the EMS system largely depends on a patient's subjective judgment [17][18][19][20]. For this reason, it is hard to set clear criteria for using the system.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Adequacy of Prehospital Emergency Medical Services Use of Patients Who Visited Emergency Departments in Korea from 2016 to 2018: Data from the National Emergency Department Information System

Park

Kim

Yoon

et al. 2021

Emergency Medicine International

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Introduction. Proper ambulance use is important not only due to the patient’s transport quality but also because of the need for efficient use of limited resources allotted by the system. Therefore, this study was conducted to check for overuse or underuse of the ambulance system by patients who visited the emergency department (ED). Methods. In this study, a secondary data analysis was conducted using the existing database of the National Emergency Department Information System with all patients who visited EDs over the three-year study period from 2016 to 2018. The study subjects were classified into the following groups: (1) appropriate Emergency Medical Services (EMS) usage; (2) appropriate no EMS usage; (3) underuse; and (4) overuse groups. Results. Of 18,298,535 patients, 11,668,581 (63.77%) were classified under the appropriate usage group, while 6,629,954 (36.23%) were classified under the inappropriate usage group. In the appropriate EMS usage group, there were 2,408,845 (13.16%) patients. In the appropriate no EMS usage group, there were 9,259,706 (50.60%) patients. As for the inappropriate usage group, there were 5,147,352 (28.13%) patients categorized under the underuse group. On the other hand, there were 1,482,602 (8.10%) patients under the overuse group. Conclusion. There are many patients who use ambulances appropriately, but there are still many overuse and underuse. Guidelines on ambulance use are necessary for the efficient use of emergency medical resources and for the safety of patients.

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What constitutes an emergency ambulance call?

Cited by 14 publications

References 27 publications

Benchmarking Triage Capability of Symptom Checkers Against That of Medical Laypersons: Survey Study

Benchmarking Triage Capability of Symptom Checkers Against That of Medical Laypersons: Survey Study

The Triage Capability of Laypersons: Retrospective Exploratory Analysis

Analysis of the Adequacy of Prehospital Emergency Medical Services Use of Patients Who Visited Emergency Departments in Korea from 2016 to 2018: Data from the National Emergency Department Information System

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